Individual
LISA MARIE KNITTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 VICTORY RD BAY COVE, BOSTON, MA 02122-3518
(617) 371-3010
Mailing address
105 VICTORY RD BAY COVE, BOSTON, MA 02122-3518
(617) 371-3010
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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